As it is known, MCP-1 (Monocyte Chemotactic Protein-1) is a protein belonging to the β subfamily of chemokines. MCP-1 has powerful chemotactic action on monocytes and exerts its action also on T lymphocytes, mastocytes and basophils (Rollins B. J., Chemokines, Blood 1997; 90: 909-928; M. Baggiolini, Chemokines and leukocyte traffic, Nature 1998; 392: 565-568).
Other chemokines belonging to the β subfamily are, for example, MCP-2 (Monocyte Chemotactic Protein-2), MCP-3, MCP-4, MIP-1α and MIP-1β, RANTES.
The β subfamily differs from the α subfamily in that, in the structure, the first two cysteines are adjacent for the β subfamily, whereas they are separated by an intervening amino acid for the α subfamily.
MCP-1 is produced by various types of cells (leukocytes, platelets, fibroblasts, endothelial cells and smooth muscle cells).
Among all the known chemokines, MCP-1 shows the highest specificity for monocytes and macrophages, for which it constitutes not only a chemotactic factor but also an activation stimulus, consequently inducing processes for producing numerous inflammatory factors (superoxides, arachidonic acid and derivatives, cytokines/chemokines) and amplifying the phagocytic activity.
The secretion of chemokines in general, and of MCP-1 in particular, is typically induced by various pro-inflammatory factors, for instance interleukin-1 (IL-1), interleukin-2 (IL-2), TNFα (Tumour Necrosis Factor Alpha), interferon-γ (interferon gamma) and bacterial lipopolysaccharide (LPS).
Prevention of the inflammatory response by blocking the chemokine/chemokine receptor system represents one of the main targets of pharmacological intervention (Gerard C. and Rollins B. J., Chemokines and disease. Nature Immunol. 2001; 2:108-115).
There is much evidence to suggest that MCP-1 plays a key role during inflammatory processes and has been indicated as a new and validated target in various pathologies.
Evidence of a considerable physiopathological contribution of MCP-1 has been obtained in the case of patients with articular and renal inflammatory diseases (rheumatoid arthritis, lupus nephritis, diabetic nephropathy and rejection following transplant).
However, more recently, MCP-1 has been indicated among the factors involved in inflammatory pathologies of the nervous system (multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer's disease, HIV-associated dementia) and other pathologies and conditions, with and without an obvious inflammatory component, including atopic dermatitis, colitis, interstitial lung pathologies, restenosis, atherosclerosis, allograft rejection following a surgical intervention (for instance angioplasty, arterectomy, transplant, organ and/or tissue replacement, prosthesis implant), cancer (adenomas, carcinomas and metastases) and even metabolic diseases such as insulin resistance, diabetes and obesity.
In addition, despite the fact that the chemokine system is involved in controlling and overcoming viral infections, recent studies have demonstrated that the response of certain chemokines, and in particular of MCP-1, may have a harmful role in the case of host-pathogen interactions. In particular, MCP-1 has been indicated among the chemokines that contribute towards organ and tissue damage in pathologies mediated by alpha viruses characterized by monocyte/macrophage infiltration in the joints and muscles (Mahalingam S. et al. Chemokines and viruses: friend or foes? Trends in Microbiology 2003; 11: 383-391; Rulli N. et al. Ross River Virus: molecular and cellular aspects of disease pathogenesis. 2005; 107: 329-342).
European patent EP-B-0 382 276 describes a number of 1-benzyl-3-hydroxymethylindazole derivatives endowed with analgesic activity. In turn, European patent EP-B-0 510 748 describes, on the other hand, the use of these derivatives for preparing a pharmaceutical composition that is active in the treatment of autoimmune diseases. Finally, European patent EP-B-1 005 332 describes the use of these derivatives for preparing a pharmaceutical composition that is active in treating diseases derived from the production of MCP-1.
2-Methyl-2-[[1-(phenylmethyl)-1H-indazol-3-yl]methoxy]propanoic acid is thought to be capable of inhibiting, in a dose-dependent manner, the production of MCP-1 and TNF-a induced in vitro in monocytes from LPS and Candida albicans, whereas the same compound showed no effects in the production of cytokines IL-1 and IL-6, and of chemokines IL-8, MIP-1α, and RANTES (Sironi M. et al., “A small synthetic molecule capable of preferentially inhibiting the production of the CC chemokine monocyte chemotactic protein-1”, European Cytokine Network. Vol. 10, No. 3, 437-41, September 1999).
Angiotensin II (A-II) is a potent vasoconstrictor that causes the muscles surrounding the blood vessels to contract, thereby significantly narrowing the blood vessels. This narrowing increases the pressure within arterial vessels, causing high blood pressure (hypertension).
Its generation in the renin-angiotensin cascade results from the action of an enzyme secreted by the kidneys, renin, on a blood plasma 2-globulin, angiotensinogen, to produce angiotensin I (A-I). A-I is then converted by angiotensin converting enzyme (ACE) to the octapeptide hormone, A-II.
In addition to renin-angiotensin system, calcium channels play an important role in pressure regulation. In both vascular and cardiac tissue, muscle cell contraction occurs when cells are depolarized from the influx of calcium through calcium channels in the cell. The increased cytosolic calcium binds to calmodulin, activating myosin light-chain kinase which phosphorylate myosin. The phosphorylated myosin can then interact with actin, resulting in muscle contraction. Calcium channel blockers inhibit muscle contraction and promote relaxation. In vascular smooth muscle this results in vessel dilation, reduced blood pressure (anti-hypertensive effect) and a reduction in the force required to pump blood by the heart.
Therefore, renin inhibitors, which inhibit the action of renin, ACE inhibitors, which inhibit the production of A-II, A-II receptor blockers or antagonists (ARBs), which inhibit the function of A-II, and calcium channel blockers or antagonists (CCBs) are useful in the treatment of hypertension.
The administration of ACE inhibitors, renin inhibitors, ARBs or CCBs results in the dilatation of the vessels and reduction of blood pressure, thereby making it easier for the heart to pump blood. ACE inhibitors, renin inhibitors, ARBs and CCbs can therefore also be used to improve heart failure as well as hypertension. In addition, they slow the progression of kidney disease due to high blood pressure or diabetes.
As a result of extensive studies, several patent and literature publications describe useful examples of ACE inhibitors, renin inhibitors, ARBs or CCBs for the treatment of heart failure and hypertension.
For example, WO2008/084504 describes several drugs in the class of ARBs, including candesartan (Atacand, Astra-Zeneca), eprosartan (Teveten, Solvay & Biovail), irbesartan (Avapro, BMS), losartan (Cozaar, Merck), olmesartan (Benicar, Medoxomil; Sankyo & Forest), telmisartan (Micardis, Boehringer Ingelheim), valsartan (Diovan, Novartis) and pratosartan (Kotobuki).
WO02/092081 describes several drugs in the class of ARBs, including candesartan cilexetil, eprosartan, irbesartan, losartan, tasosartan, telmisartan, and valsartan.
Renin inhibitors like aliskiren, ditekiren, enalkiren, remikiren, terlakiren, ciprokiren and zankiren are described in several patents and patent applications like U.S. Pat. No. 5,559,111, EP 173,481, EP 311,012, EP 416,373, EP 266,950, EP 456,185, and EP 509,354.
US2008/0139511 describes several drugs in the class of ACE inhibitors, including benazepril, captopril, cilazapril, enalapril, enalaprilat, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril.
U.S. Pat. No. 5,977,159 describes the use of an ACE-inhibitor for treatment of dyspeptic symptoms, the ACE inhibitor being selected from alacepril, alatriopril, altiopril calcium, ancovenin, benazepril, benazepril hydrochloride, benazeprilat, benzazepril, benzoylcaptopril, captopril, captopril-cysteine, captopril-glutathione, ceranapril, ceranopril, ceronapril, cilazapril, cilazaprilat, converstatin, delapril, delapril-diacid, enalapril, enalaprilat, enalkiren, enapril, epicaptopril, foroxymithine, fosfenopril, fosenopril, fosenopril sodium, fosinopril, fosinopril sodium, fosinoprilat, fosinoprilic acid, glycopril, hemorphin-4, idapril, imidapril, indolapril, indolaprilat, libenzapril, lisinopril, lyciumin A, lyciumin B, mixanpril, moexipril, moexiprilat, moveltipril, muracein A, muracein B, muracein C, pentopril, perindopril, perindoprilat, pivalopril, pivopril, quinapril, quinapril hydrochloride, quinaprilat, ramipril, ramiprilat, spirapril, spirapril hydrochloride, spiraprilat, spiropril, spiropril hydrochloride, temocapril, temocapril hydrochloride, teprotide, trandolapril, trandolaprilat, utibapril, zabicipril, zabiciprilat, zofenopril and zofenoprilat.
Calcium channel blockers or antagonists (CCBs) are widely used alone or in combination with other antihypertensive drugs in the treatment of heart failure and hypertension. CCBs include dihydropyridine, phenylalkylamine, and benzothiazepine derivatives, and are widely described in patent and literature references, such as, for example, in U.S. Pat. Nos. 6,268,377 and 5,209,933, herein incorporated for reference.
The statins (or HMG-CoA reductase inhibitors) are a class of drugs that lower cholesterol levels in people with or at risk of cardiovascular disease. Statins lower cholesterol by inhibiting the enzyme HMG-CoA reductase, which is the rate-limiting enzyme of the mevalonate pathway of cholesterol synthesis. Inhibition of this enzyme in the liver results in decreased cholesterol synthesis as well as increased synthesis of LDL receptors, resulting in an increased clearance of low-density lipoprotein (LDL) from the bloodstream.
The statins are divided into two groups depending on their source. Fermentation-derived statins include lovastatin, mevastatin, pravastatin, simvastatin. Synthetic statins include atorvastatin, cerivastatin, fluvastatin, pitavastatin, and rosuvastatin.
The statins are described in a number of patent and literature publication, such as, for example, U.S. Pat. No. 6,911,472, U.S. Pat. No. 7,459,447, U.S. Pat. No. 7,498,359, U.S. Pat. No. 7,183,285, and Akira Endo, “The discovery and development of HMG-CoA reductase inhibitors” J. Lipid Res. Vol. 33 (1992), pp 1569-82.